Can Galantamine (galantamine) Extended Release (ER) tablets be crushed?

Galantamine ER Tablets Should Not Be Crushed

Galantamine extended-release (ER) tablets should not be crushed as this would destroy the extended-release properties of the medication, potentially leading to higher peak concentrations, increased side effects, and reduced efficacy. 1, 2

Why Galantamine ER Tablets Should Not Be Crushed

Pharmacokinetic Considerations

• Galantamine ER is designed to provide controlled drug release over time, with peak concentrations (Cmax) occurring at approximately 4 hours after administration, compared to 1 hour for immediate-release formulations 3
• Crushing extended-release formulations disrupts their intended release mechanism, potentially causing:
  • Immediate release of the full dose ("dose dumping")
  • Higher peak plasma concentrations
  • Shorter duration of therapeutic effect
  • Increased risk of adverse effects 1, 2

Safety Concerns

• Altered absorption of galantamine when crushed may lead to:
  • Increased risk of cholinergic side effects (nausea, vomiting, diarrhea, bradycardia) due to higher peak concentrations 4
  • Potentially dangerous fluctuations in drug levels that could impact cognitive function 1
• The most common side effects of galantamine (nausea, vomiting, diarrhea) could be exacerbated by crushing the ER formulation 4

Alternative Options

Consider Alternative Formulations

• If the patient has difficulty swallowing tablets, consider:
  • Switching to galantamine immediate-release formulation, which may be available in different dosage forms that are easier to administer 4
  • Consulting with a pharmacist about alternative medications for Alzheimer's disease that may be available in liquid or other more easily administered forms 4

Medication Administration Considerations

• For patients with swallowing difficulties:
  • Consult with a pharmacist before modifying any medication, especially extended-release formulations 4, 2
  • Consider a medication review to determine if alternative cholinesterase inhibitors with different formulations might be appropriate 4
• For patients requiring enteral feeding:
  • Extended-release medications should generally not be administered through feeding tubes 4, 2
  • A pharmacist should be involved in developing an appropriate medication administration plan 4

Clinical Implications

Efficacy Concerns

• Crushing galantamine ER tablets would likely alter the pharmacokinetic profile, potentially reducing the medication's effectiveness in managing Alzheimer's disease symptoms 3, 5
• The therapeutic benefits of galantamine in improving cognitive function, activities of daily living, and behavioral symptoms depend on maintaining appropriate drug levels 4, 5

Monitoring Recommendations

• If a patient is unable to take galantamine ER as prescribed:
  • Assess the patient's response to any alternative formulation or medication 4
  • Monitor for increased side effects or changes in cognitive function 4
  • Consider discontinuing galantamine if side effects develop and do not resolve, adherence is poor, or deterioration continues at the pretreatment rate after six to 12 months of treatment 4

Common Pitfalls to Avoid

• Assuming that all tablets can be safely crushed without checking with a pharmacist 1, 6
• Failing to consider the legal implications of modifying medications outside their licensed use 6
• Not exploring alternative formulations or medications before resorting to crushing tablets 2
• Overlooking the potential for drug-drug interactions when changing formulations 3

Remember that altering medication dosage forms can have significant clinical, legal, and safety implications. Always consult with a pharmacist before crushing any tablet or opening any capsule 4, 1, 2.